中性粒细胞与淋巴细胞比值对急性肾损伤预测作用的Meta分析

A Meta-analysis of the predictive effect of neutrophil-lymphocyte ratio on acute kidney injury

目的系统评价中性粒细胞与淋巴细胞比值(NLR)对急性肾损伤(AKI)的预测价值。方法电子检索美国国立医学图书馆PubMed数据库、荷兰医学文摘(Embase)数据库、中国生物医学文献数据库(CBMdisc)以及中国循证医学/Cochrane中心数据库(CEBM/CCD)等从建库至2020年10月发表的有关评估NLR对AKI预测作用的研究,不限语种、地区以及有无使用盲法。由2名研究者独立提取数据,并对文献质量进行评价,使用RevMan 5.3软件进行Meta分析,评价NLR对AKI的预测价值,并对纳入文献按不同国家、不同疾病类型(心血管手术、感染性疾病及烧伤、肝硬化和急诊等其他疾病)、不同样本量(≤300例和>300例)进行亚组分析,评价NLR对AKI的预测价值;使用漏斗图评价NLR对AKI预测作用纳入文献的发表偏倚。结果共11篇文献被纳入本次Meta分析,包含4 997例患者,AKI组1 308例,非AKI组3 689例。Meta分析结果显示:NLR升高对AKI的发生有一定预测价值〔均数差(MD)=2.73,95%可信区间(95%CI)为1.78~3.68,P<0.000 01〕;亚组分析结果显示:来自东南亚地区(MD=4.04,95%CI为1.09~6.99,P=0.007)和来自欧亚地区(MD=2.51,95%CI为1.12~3.90,P=0.000 4)患者NLR升高对AKI的发生有一定预测价值。心血管疾病手术(MD=0.77,95%CI为0.34~1.20,P=0.000 4)、感染性疾病(MD=4.74,95%CI为1.51~7.96,P=0.004)和其他疾病(MD=8.53,95%CI为6.26~10.80,P=0.000 01)患者NLR的升高均对AKI的发生有一定预测价值。样本量≤300例(MD=6.02,95%CI为4.90~7.14,P<0.000 01)和样本量>300例(MD=1.32,95%CI为0.61~2.03,P=0.000 3)的研究NLR升高对AKI的发生亦有预测价值。漏斗图分析可见散点分布基本对称,提示纳入研究无明显发表偏倚。结论 NLR可以作为AKI的重要预测工具。

Objective To systematically evaluate the predictive value of neutrophil-lymphocyte ratio(NLR)in acute kidney injury(AKI).Methods All studies about the predictive effect of NLR on AKI were searched in the National Medical Library of the United States PubMed Database,the Embase database in the Netherlands,the Chinese Biology Medicine disc(CBMdisc)and the Chinese Evidence Based Medicine Cochrane Centre Database(CEBM/CCD).The data updated by October 2020,and regardless of language,region or whether blind method was used.Two authors independently extracted data and evaluated the quality of the studies.Data extracted from the studies were analyzed with RevMan 5.3 to assess the predictive value of NLR on AKI.A subgroup Meta-analysis was conducted to assess the predictive value of NLR on AKI according to different countries,different disease types(cardiovascular surgery,infectious diseases,other diseases including burns,cirrhosis,and emergency),and different sample sizes(≤300 cases and>300 cases).The publication bias of included studies about the predictive effect of NLR on AKI were assessed by funnel plots.Results A total of 11 studies were included in this Meta-analysis,including 4997 patients,1308 patients in AKI group,and 3689 patients in non-AKI group.The Meta-analysis results showed that:increased NLR had predictive value for the occurrence of AKI[mean difference(MD)=2.73,95%confidence interval(95%CI)was 1.78-3.68,P<0.00001].Subgroup analysis showed that increased NLR had predictive value for the occurrence of AKI in patients from Southeast Asia(MD=4.04,95%CI was 1.09-6.99,P=0.007)and Eurasia(MD=2.51,95%CI was 1.12-3.90,P=0.0004).Increased NLR had predictive value for the occurrence of AKI in patients undergoing cardiovascular surgery(MD=0.77,95%CI was 0.34-1.20,P=0.0004),infectious diseases(MD=4.74,95%CI was 1.51-7.96,P=0.004)and other diseases(MD=8.53,95%CI was 6.26-10.80,P<0.00001).Increased NLR had predictive value for the occurrence of AKI in studies with a sample size of≤300 cases(MD=6.02,95%CI was 4.90-7.14,P<0.00001)and>300 cases(MD=1.32,95%CI was 0.61-2.03,P=0.0003).There was no significant publication bias in the included studies assessed by funnel plots.Conclusion NLR is an important predictive tool for AKI.